Palazzi M, Cataldo I, Gramaglia A, De Toma D, Milani F, Ravasi G
Department of Radiotherapy, Istituto Nazionale Tumori, Milan, Italy.
Int J Radiat Oncol Biol Phys. 1993 Oct 20;27(3):621-5. doi: 10.1016/0360-3016(93)90388-c.
To evaluate the therapeutic effectiveness of a combined chemoradiotherapy program, followed by surgery in selected cases, in Stage III non-small cell lung cancer.
Between August 1988 and February 1990, 43 patients Staged IIIa-b (UICC 1987, 58% IIIb) have been treated with concomitant chemotherapy (cisplatin 15 mg/m2 and VP16 75 mg/m2, 5 days a week on week 1 and 5) and radiotherapy (40 Gy split course, 2 Gy/day on week 1, 2, 5, and 6), followed by attempted curative thoracotomy or more cycles of full dose chemotherapy with the same two drugs.
Planned chemoradiotherapy has been given to 91% of patients; 13/43 patients have been operated, with 12 complete resections and three (7%) pathological complete responses. Toxicity was significant, with two postoperative deaths and two fatal radiation pneumonitis. Crude progression-free survival rate is 21% at 30 months, with nine patients (21%) alive and free from progression at follow-up times ranging from 31 to 49 months. Subset survival analysis showed a possibly greater therapeutic effect for non-squamous histology as compared to squamous carcinoma.
These results are encouraging in a cohort of patients with quite advanced disease (58% Stage IIIb).
评估针对Ⅲ期非小细胞肺癌采用联合放化疗方案并在部分病例中后续行手术治疗的疗效。
1988年8月至1990年2月期间，43例Ⅲa - b期（国际抗癌联盟1987年分期，58%为Ⅲb期）患者接受了同步化疗（顺铂15 mg/m²和依托泊苷75 mg/m²，第1周和第5周每周5天）及放疗（40 Gy分割疗程，第1、2、5和6周每天2 Gy），随后尝试进行根治性开胸手术或使用相同的两种药物进行更多周期的全剂量化疗。
91%的患者接受了计划的放化疗；13/43例患者接受了手术，其中12例完全切除，3例（7%）病理完全缓解。毒性反应显著，有2例术后死亡和2例致命性放射性肺炎。30个月时的粗无进展生存率为21%，9例患者（21%）在31至49个月的随访期内存活且无疾病进展。亚组生存分析显示，与鳞状细胞癌相比，非鳞状组织学类型可能具有更大的治疗效果。
对于一组病情相当晚期（58%为Ⅲb期）的患者，这些结果令人鼓舞。
